Intravitreal injections of the corticosteroid triamcinolone may slow the progression of diabetic retinopathy in people with macular edema, a clinical trial has found.

However, the researchers say that triamcinolone cannot be currently recommended for this indication in view of its potential to cause adverse effects, including cataracts and glaucoma.

The findings come from an exploratory analysis of data from a clinical trial in which 840 eyes from 693 participants with diabetic macular edema were randomly assigned to receive laser therapy or intravitreal triamcinlone acetonide 1 or 4 mg.

Laser therapy (also known as focal/grid photocoagulation), along with glycemic control, are the current standard treatments for proliferative diabetic retinopathy (PDR). However, laser therapy is inherently destructive and associated with adverse events, potential complications, and the progression of visual loss in around 5% of treated individuals.

In the current study, analysis of the primary endpoint showed that the cumulative probability of progression of retinopathy at 2 years was 31% in the laser group, 29% in the triamcinolone 1 mg group, and 21% in the triamcinolone 4 mg group. The difference between laser therapy and high-dose triamcinolone was statistically significant.

These differences were sustained at 3 years, remark Neil Bressler (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) and fellow researchers writing in the Archives of Ophthalmology. This is particularly interesting since most eyes did not receive regular corticosteroid injections in the second year and less than 50% received any corticosteroids in the third year.

“Theoretically, it is possible the reduction in risk of retinopathy progression may have been even greater if intravitreal triamcinolone had been given more frequently between years 1 and 3 of follow-up,” the researchers suggest.

Importantly, however, they admit there are limited data from the scientific literature to support the hypothesis that anti-inflammatory medications such as corticosteroids reduce the risk for ocular progression toward the threshold of PDR. Furthermore, the treatment confers a significant risk for complications.

“Use of this intravitreal corticosteroid preparation to reduce the likelihood of progression of retinopathy is not warranted at this time because of the increased risk of glaucoma and cataract,” Bressler et al conclude.

“Nevertheless, further investigation with regard to the role of pharmacotherapy for reduction of the incidence of progression of retinopathy appears to be warranted.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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